Dying is one of the few events in life certain to occur, yet one we are not likely to plan for.

We spend more time getting ready for two weeks away from work than we do our last time on Earth.

  |  Why Prearrange?  |  How to Prearrange Online  |  Frequently Asked Questions  |  Glossary  |  Funeral Homes  |  Funeral Services

Online Arrangement Form

Date:  (month/day/year)
Full Name:

TABLE OF CONTENT

  • Part 1 - Personal Information: Tell us about yourself.
  • Part 2 - Executor's Information: Who is the person you've chosen to carry out your final wishes?
  • Part 3 - Family Information: Help us locate, inform and take care of your family members.
  • Part 4 - Military Record: If applicable, tell us about your military record.
  • Part 5 - Service Selection: Select your preferences for visitations, your service, a casket or urn, as well as your preferred disposition method.
  • Part 6 - Important Documents & Information: Help your family easily locate all your personal information.
  • Part 7 - More Information & Appendix

Make sure you have all the necessary information needed for you to fill out this Pre-Arrange Online form before beginning your journey into setting your final wishes.
Part 1 - Personal Information
This section will help the funeral director as well as your executor and/or family members ensure that your estate is finalized and taken care of in an efficient manner.
Full Name:
Address1:
Address2:
City:
State/Province:
Zip/Postal Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State/Province of Birth:
Highest Education Level:
Please select degree completed:
SSN / SIN:
Residence History:
Your Occupation:
Industry:
Company Name:
Church:
Lodge or Union Name:
Part 2 - Executor's Information
The executor of your will and/or your estate will be responsible for protecting your estate. This includes carrying out your funeral arrangements. By prearranging, you are giving them direction and help. It is important for the funeral director to know who this person is as there might be final decisions that need to be made and the executor would be responsible in those situations. If you do not currently have an executor, please let us know who you'd like the funeral director to communicate with regarding your funeral arrangements.
Full Name:
Address1:
Address2:
City:
State/Province:
Zip/Postal Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Please select your relationship to the executor:
If Other:
Part 3 - Family Information
Building a register for your family's information is an important part of estate planning. Please ensure that the information is accurate, if any changes need to be made in the future, you may log back in to keep your file updated. If you require more entries, please use the Appendix area in section 7.
Marital Register:
Spouse's Name:
Spouse's Maiden Name:
Relationship:

Parental Register:
Father's Name:
Father's City of Residence:
Is your father deceased?
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Is your mother deceased?

Children's Register:
Eldest's Child Name:
Eldest's City of Residence:
Eldest's Date of Birth: (month/day/year)
Eldest's City of Birth:
Is your eldest child married?
If so, name of spouse:
Is your eldest child deceased?
If so, date of death: (month/day/year)
Second Child Name:
Second's City of Residence:
Second's Date of Birth: (month/day/year)
Second's City of Birth:
Is your second child married?
If so, name of spouse:
Is your second child deceased?
If so, date of death: (month/day/year)
Third Child Name:
Third 's City of Residence:
Third 's Date of Birth: (month/day/year)
Third 's City of Birth:
Is your third child married?
If so, name of spouse:
Is your third child deceased?
If so, date of death: (month/day/year)

More Information:  (if more space is needed, please use the Appendix in section 7)
Other survivors' names, relationship and cities of residence:
Other relatives who have preceded you in death:
Part 4 - Military Record
This section is optional, if you have not served in the military, please move to section 5.
Veteran:
Branch of Service:
I.D. Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a copy of discharge papers:
Military Honors at Graveside:
Flag Preference for Service:
Part 5 - Service Preferences
Your funeral service will allow your loved ones and friends to say their last goodbyes. The service plays an important role in the grieving process. While prearranging helps relieve the pressure put on the family and/or the executor, it also allows you to make sure your final wishes are respected.
What would you like be done with your body?

Your Visitation Preferences:
Would you like to have visitations with the presence of your remains?
When would you like the visitations to take place?
How many public visitations times/days would you like:
How many private visitations times/days would you like:
What are your preferences for visitation hours:
If you've chosen direct cremation, would you like the urn present at visitations?
Please inform us of any special requests you might have regarding your visitations:
For the viewings, would you prefer your casket:
Would you like your death announced in the newspapers?
Would you like a photograph in the announcement?
Please list which newspapers you'd like to send your notice to:
What would be the message you’d like to leave?
Would you rather friends and family send a donation to a specific charity in lieu of flowers?
If so, which charities?

Your Service Preferences:
What type of service would you like?
Where would you like your service held?
Did you have specific clergy member(s) in mind?
Or, if you'd prefer a non-religious ceremony, do you have any other choice of celebrants?
Would you like to specify a list of pallbearers?
Did you have some music selected?
Would you like to have some texts read?
What are your preferences regarding flower arrangements
What would you like done with any jewelry?
What would you like done with your glasses?
Please inform us of any special requests you might have regarding your service:

Your Disposition Preferences:
Select the disposition method you've chosen:
Please select your casket preferences:
Do you have any special requests regarding your casket selection?
If cremation is chosen, I would like my ashes to be:
Do you have any special requests regarding the disposal of your ashes?
Please select your urn preferences:
Where would you like to have your remains buried? Please give us the cemetery name:
If you have chosen to have your urn placed in a columbarium, please name it here:
The cemetery/niche property is in the name of:
Do you have any other special requests regarding your burial or cremation?
Part 6 - Important Documents

If you wish to inform the funeral home and your family of the location of some important documents, please use this section to record this important information.

Important Documents - For each document, please indicate its location:
Birth certificate:
Please specify:
Marriage contract:
Please specify:
Will:
Please specify:
Prearrangement documents:
Please specify:
Licences/permits:
Please specify:
Bonds/Loans/Investments:
Please specify:
Bank documents:
Please specify:
Fiscal documents:
Please specify:
Contracts/Leases/Mortgages:
Please specify:
Life Insurance:
Policy number:
Insurance broker's contact information:
Please specify:
Other Insurance:
Policy number:
Insurance broker's contact information:
Please specify:
Stocks/Mutual Funds/Investments:
Please specify:
Broker's contact information:

Real Estate Information:
Property 1 Address:
Type of property:
Mortgage information:
Property 2 Address:
Type of property:
Mortgage information:

Banking Information:
Name of financial institution:
Branch information:
Type of accounts:
Type of loans:
Name of financial institution:
Branch information:
Type of accounts:
Type of loans:

Safety Deposit Boxes:
Location:
Box number:
Location of key:
Location:
Box number:
Location of key:

Credit and Debit Cards:
Card issuer:
Account number:
Card issuer:
Account number:
Card issuer:
Account number:

Part 7 - Miscellaneous Notes and Instructions
Appendix:

 

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